Terms of Reference

1. Terms of Reference Primary Health care in Azerbaijan monitoring the budget and developing mechanisms of efficient allocations

2. Background • Only one-fifth of total healthcare expenditure in Azerbaijan is directed to PHC services. AZN 27.9 million (US$ 31 million) has been allocated to PHC from the State Budget-2006 and its share in total healthcare expenditure is 18.5%. That means the annual amount of public healthcare costs is $3 per capita. (WHO standards are $15-$20)

3. The overall goal of the project • Project aims at improving transparency of budget processes through developing a model, which allows assessing effectiveness of budget expenditure in primary health care. • In the long-term perspective, this will contribute to improving the quality of primary health care in Azerbaijan.

4. The focus point • The expenditures at all levels of distribution: • Sources: MoF • Agents: MoH, Finance department at district levels; Central hospital; Rural executive bodies; • Providers: clinics and hospitals Source → agent → provider

5. Study aim and objectives • To identify efficiency of budget expenditure in two pilot districts on primary health care in 2005*. • To develop the model and mechanisms for effective and efficient use of budget expenditure in PHC. * The fiscal and calendar year are the same in Azerbaijan.

6. Rationale & source of data • The research will track officially reported actual expenditures of MoH on PHC in 2005. The research might slightly touch other sources of funding (for ex., out-of-pocket expenditures of the patients) • In order to receive the information a budget documentation will be obtained. The project group will officially request all appropriate organizations/institutions to provide an additional information. The personal contacts/relations will be used. The project will conduct survey among health care workers in PHC clinics/hospitals. The second survey will be conducted among population.

7. The funds allocated in the budget will be measured with the actual expenditures stated in the documentation of service providers (i.e. clinics and hospitals). The indicators to be used: PHC per capita expenditures according to the official information from MoH and those stated in the clinics/hospitals. • The analysis will include analysis of the beneficiary groups and object of expenditures. • During the research the functional cost analysis will be performed

8. Advocacy • The results of the study i.e. quantitative and description reports will be submitted to Working group on health reforms, MoH and MoF officials, parliament and to international organizations such as WHO, WB, WMF • The results of the research will be submitted to the officials and international organizations in the form of the official report. The meetings will be conducted with all the listed organizations. The results will also be discussed on round tables with representatives of civil society, experts and the mass media. • The specific detailed reports will be submitted to NGOs and the mass media.

9. The project will use the capacities of: • National Budget Group (which includes 9 strongest NGOs) • NGOs working in health sector; • Mass media, both publishing and TV; • Representatives of Social & Economic Committees of the Parliament

10. Our messengers: • Head of Committees in the Parliament • NGO alliances • Initiative groups

11. There are several health reform projects are being performed by WHO, WB and USAID in Azerbaijan. The project group will conduct meetings with the representatives and provide the research results and the project’s suggestions to these organizations • There will be organized a forum with participation of regional and international experts on organization of health care. • The project intends to conduct TV debates and talk shows; develop PSAs.

12. Expected results • To improve the budget mechanisms in healthcare system; • To make the PHC more efficient and accessible for vulnerable groups

13. Thank you!